Soft tissue Balancing In Varus Knee Yazdi HR MD Fellowship of Knee surgery Associated Professor of IUMS Do you do tis patient? What is your approach? How do you balance the knee?
Which implant do you prefer? Techniques : gap technique and the measured resection technique Gap technique may result in residual varus alignment in flexion( Whiteside et al)
Bone resections :according to the preoperative template on the long WB films
Tibial cutting jig :according to the talus center distally and the plateau-to-anatomic axis intersection proximally.
In constitutional metaphyseal varus deformities: usually
facing the lateral tibial plateau spine initial medial release
medial flap of tissue, which includes the meniscotibial fibers of the deep medial collateral ligament sublux the tibia forward in flexion and external rotation (RanSall maneuver) violating the posterior tibial osteophyte(pagoda) tibial and femoral
osteophytes are removed Do proximal tibial and distal femoral cuts Anteror and posterior femoral cuts
Medial pivot if needed Tight soft tissue structures in varus knees PCL Posterior capsule
Posteromedial corner with the posterior oblique Ligament (POL) Semimembranosus (direct tibial insertion) Posterior fibers of the superficial MCL
All these structures can be released with the knee in Flexion Release posterior capsule can be addressed
by a periosteal elevator
from the femoral side. figure four position to release SM and POL Release MCL Pie-crusted with a 16 Gauge needle with
multiple Punctures Distal release Shift and resect technique Medial epicondylar Ost. Effect of medial epicondylar osteotomy on soft tissue
balancing in total knee arthroplasty. Mihalko WM, Saeki K, Whiteside LA. findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used. Orthopedics. 2013 Nov 1;36(11):e1353-7
Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity. Engh GA, Ammeen D. The results show that epicondylar osteotomy for varus knee deformity provides excellent patient satisfaction, knee stability, motion, and deformity correction.
Clin Orthop Relat Res. 1999 Oct;(367):141-8. Medial epicondyle osteotomy: a method of choice in severe varus knee arthroplasty Horia Orban Gabriel Stan Mihaela Dragusanu Razvan Adam Using medial epicondyle osteotomy for varus knee when performing total knee arthroplasty could be a useful ligament-balancing technique
to achieve medial stability of the knee. In addition, it could have considerable advantages towards the additional resection of the tibial medial plateau. European Journal of Orthopaedic Surgery & Traumatology 2012 | 22 | 7 | 579-583 Fibular Ost.
A 65 Y/o F Sever Bi varus deformity End Results Thank you
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